ASSESSMENT OF THE

HEAD AND NECK

 Inspection of the Shape of the Head

◼ Have the patient sit in a comfortable

position.
◼ Face the patient, with your head at the
same level as the patient’s head
◼ Inspect the head for shape and symmetry
N – The head should be normocephalic and
symmetrical

Abnormal Findings
◼ HYDROCEPHALUS is an ◼ It is caused by an
enlargement of the head abnormal accumulation of
without enlargement of CSF within the skull.
the facial structures.
◼ ACROMEGALY is an
◼ It is caused by
abnormal enlargement of
the skull and the bony
excessive secretion of
facial structures. growth hormone from
the pituitary gland
Hydrocephalus
Acromegaly facial changes
 Cryniosyostosis
◼ CRYNIOSYNOSTOSIS ◼ Is caused by
is characterized by premature closure of
abnormal shape of one or more sutures
the skull or bone of the skull before
growth at right angles brain growth is
to suture lines, complete.
exopthalmos, and
drooping eyelids
 PALPATION OF THE HEAD

◼ Place the finger pads on the scalp and palpate

all of its surface, beginning in the frontal area
and continuing over the parietal, temporal, and
occipital areas.
◼ Assess for contour, masses, depressions,
tenderness.
◼ Palpate the superficial temporal artery, which is
located anterior to the tragus of the ear.
Normal Findings

◼ The normal skull is smooth and

nontender, and without masses or
depressions. The temporal artery is
usually a weaker peripheral pulse than the
other peripheral pulses of the body.
Abnormal Findings

◼ Palpation elicits ◼ Osteomyelitis of the

localized edema over skull may develop
the bony frontal following acute or
portion of the skull. chronic sinusitis if the
infection extends out
from the sinuses into
the surrounding bone.
 Inspection and Palpation of the Scalp

◼ Part the hair repeatedly all over the scalp

and inspect the scalp for lesions or
masses.
◼ Place finger pads on the scalp and palpate
for lesions or masses.
N- The scalp should be shiny, intact,
and without lesions or masses.
Abnormal Findings
◼ A laceration or a ◼ Direct trauma can
laceration with cause lacerations to
bleeding is abnormal. the scalp.
INSPECTION AND PALPATION OF
THE NECK
 INSPECTION OF THE NECK

◼ Inspect for the symmetry of the

sternocleidomastoid muscles anteriorly,
and the trapezii posteriorly.
◼ Have the patient touch the chin of the
chest, to each side, and to each shoulder.
◼ Assess for limitation of motion.
◼ Note the presence of stoma or
tracheostomy.
Normal Findings

◼ The muscles of the neck are symmetrical

with the head in a central position. The
patient is able to move the head through a
full range of motion without complaint or
discomfort or noticeable limitations.
Abnormal findings

◼ The patient ◼ Pain with flexion can

complaints of pain be associated with
with flexion or the pain and muscle
rotation of the head. spasm caused by
meningeal irritation of
meningitis
◼ If lymph nodes are palpated, their size, location,
consistency, mobility, and tenderness should be
noted.
◼ Abnormal findings are: abnormal sounds heard
over the thyroid gland with auscultation,
asymmetry of the neck, and enlarged thyroid
gland.
◼ Masses in the thyroid are abnormal.
◼ Hoarseness will be noted if there is abnormality
in the larynx.
◼ The duration of hoarseness should be determined.
◼ Prolonged hoarseness is a common symptoms of
malignancy.
Inspection of the Face
SYMMETRY

◼ Have the patient sit in a comfortable

position facing you.
◼ Observe the patient’s face for expression,
shape and symmetry of the following
structures: eyebrows, eyes, nose, mouth
ears.
Normal Findings

◼ The facial features should be symmetrical.

It is important to remember that slight
variations in symmetry are common.
Slanted eyes with inner epicanthial folds
are normal findings in patients of Asian
descent.
Abnormal Findings

◼ Structures are absent ◼ It may indicate

or deformed. There is
definite asymmetry of
expression, the
palpebral fissures, the
nasolabial folds, and
the corners of the
mouth.
damage to the nerves
innervating facial
muscles (CN VII), as
in stroke or Bell’s
palsy.
 Shape and Features

◼ N- The shape of the face can be oval,

round, slightly square. There should be no
edema, disproportionate structures, or
involuntary movements.
Abnormal Findings

◼ Inspection of the face ◼ These findings are

may reveal slanted likely to indicate the
eyes with inner presence of Down
epicanthal folds; a syndrome, a
short, flat nose; and a chromosomal
thick, protruding aberration.
tongue.
◼ HYPERTELORISM an ◼ It is a congenital
abnormally wide anomaly.
distance between the
eyes.
◼ Graves’ disease is an
◼ EXOPTHALMOS in autoimmune disorders
Graves’ disease – the associated with
face is thin with increase circulating
sharply defined levels of T3 and T4.
features and
prominent eyes.
hypertelorism
exopthalmos
◼ MYXEDEMA – the ◼ It is associated with
patient’s face is round hyperthyroidism
and swollen with
characteristics
periorbital edema and
dry, dull skin.
Thank you